AUCTORES
Globalize your Research
Research | DOI: https://doi.org/10.31579/2693-4779/053
1 Professor of Pathology, Consultant Microbiologist, Al Nafees Medical College & Hospital, Islamabad.
2 Head Department of Microbiology, Consultant Microbiologist, Armed forces Institute of Pathology, Rawalpindi.
3 Assistant Professor of Pathology, Consultant Microbiologist,Armed forces Institute of Pathology, Rawalpindi
4 Assistant Professor of Pathology, Consultant Microbiologist,Armed forces Institute of Cardiology, Rawalpindi
*Corresponding Author: Humaira Zafar, Professor of Pathology, Consultant Microbiologist, Al Nafees Medical College & Hospital, Islamabad.
Citation: H Zafar, I A Mirza, W Hussain, M Fayyaz. (2021) Black Fungus an Escalating Threat for Covid-19 Patients Calling out Captivation. Clinical Research and Clinical Trials. 4(2); DOI: 10.31579/2693-4779/053
Copyright: © 2021 Humaira Zafar. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 18 June 2021 | Accepted: 22 July 2021 | Published: 20 August 2021
Keywords: black fungus; mucormycosis, covid 19; immunosuppression; anti virals; prolong hospital stay; use of tocilizumab; steroids; systemic anti-fungal
Background
Current year 2021, brought a hope for the world due to availability of various vaccines to prevent COVID 19. Researchers around the Globe, kept working around the clock to dig up various correlations of this infection. So, that morbidity and mortality rates can be reduced. In all this sprint, cases of black fungus came into light in India. The Indian researchers identified strong association of black fungus co infection in COVID patients resulting in high mortality rates.
Objectives
Therefore, this current systematic review was planned to identify the predisposing factors, clinical presentations and management options for black fungus in COVID 19 patients.
Methodology: This ‘systematic review’ was carried out following preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines & various search engines. Total 20(N) articles were selected and included for study. After following PRISMA guidelines and based upon inclusion and exclusion criteria of study, total 05 (N) manuscripts, were included.
Results
Out of 05(N) selected articles, 80 %( 04) strongly supported strong association of black fungus with COVID 19 patients. The highlighted predisposing factors includes, immunosuppression, anti virals, prolong hospital stay, use of tocilizumab and steroids as management of COVID patients. Timely diagnosis and provision of anti-fungal can be helpful to reduce mortality form this co infection.
Conclusion
It is concluded that immunosuppression, anti virals, prolong hospital stay, use of tocilizumab and steroids as management of COVID predisposes to black fungus. Timely diagnosis and use of systematic anti fungals can reduce mortality rate form this co infection.
In the year 2019, emergence of COVID 19 called a hue and cry around the Globe. Absence of specific management and non-availability of vaccination kept on adding to the miseries of patients. Current year 2021, brought a hope for the world due to availability of various vaccines to prevent COVID 19. Researchers around the Globe, kept working around the clock to dig up various correlations of this infection. So, that morbidity and mortality rates can be reduced. Despite the passage of more than 1.5 years, many mysteries of this infection are yet to be discovered.
In all this sprint, cases of black fungus came into light in India. The Indian researchers identified strong association of black fungus co infection in COVID patients resulting in high mortality rates. The black fungus is also well known by a name of Mucormycosis. This supports many globally conducted studies which clinched that Corona virus infects the persons having weakened immune system. So, in current pandemic situation, due care should be taken to improve personal immunity. This can be achieved by taking healthy and balanced diet, exercise, along with good sleep and adoption of stress free life style. This will be a simple solution to get ourselves saved from acquiring this infection [1].
Immunodeficiency can be the result of either primary or secondary causes. The primary immunodeficiency is usually present at birth, while secondary is the one acquired during the passage of life. There can be many causes of secondary immunodeficiency like malnutrition, extreme of ages, prolong debilitated illnesses, complicated surgeries or any other illnesses requiring prolonged hospital stay especially in intensive care units (ICUs), and organ transplantation. Uncontrolled diabetes, cancers, use of steroids, chemotherapeutic drugs, intra venous drug abusers, and Human immunodeficiency viral infection are other added causes. Even the exhaustive, hectic routines, extreme work pressure, hidden stresses of daily life etc all can be the triggering factors for immunodeficiency. Moreover, depending upon the underlying condition, it can be mild to severe in intensity. Hence, the decision for management depends upon the cause and severity of signs and symptoms [2].
The latest available data highlighted predisposing factors includes, immunosuppression, anti virals, prolong hospital stay, use of tocilizumab and steroids as management of COVID patients [3]. Timely diagnosis and provision of anti-fungal can be helpful to reduce mortality form this co infection [4].
In view of existing hue and cry for co-existing black fungus worsening COVID 19 scenario, thi systematic review was planned. The objectives were to identify the predisposing factors, clinical presentations and management options for black fungus in COVID 19 patients.
This systematic review was carried out by PRISMA guidelines – 2019 [5]. Total 24 studies were selected and included for study. The search was carried out in four stages i.e identification, screening, eligibility and final included ones. The details are shown in figure- I.
Certain MESH key words were used for searching the relevant literature review. These key words were Black fungus, COVID 19, immunosuppression, anti virals, prolong hospital stay, use of tocilizumab, steroids, systemic anti-fungal. The meta-analysis, systematic review, original articles, review articles and guidelines published in impact factor journals in last 05 years were included. While amongst all these the ones having details for symptoms of COVID in any age group, with or without symptoms of black fungus/mucormycosis were included. However, editorials, letter to editor, case reports, commentary, case series report and short communications were excluded.
Twenty four studies (n=24) were included for the systematic review. Out of 20 (n), 09 (n) were from selected from PUBMED, 02 (n) from Cochrane Data Base, 07 (n) from Google scholar, 01 (n) from open google search and 01 (n) was selected from PakMedinet. 04 (n) articles were selected by snowball method form one meta-analysis. This is shown in figure 1. For standardization of selected articles, critical appraisal was done for finally selected 05 (N) articles. Out of them, 02 were review articles, o1 was systematic review, one was meta-analysis and 01 was original article. The salient points for 05 selected articles is shown in table I.
The salient results extracted from the critical appraisal of 05 selected articles are shown in table I. It was identified that, the estimated prevalence of black fungus / Mucormycosis is 2–6%. Amongst which Rhizopus, Mucor and Lichtheimia are responsible ones i.e 34
COVID 19 infection, is believed to have strong association with immunodeficiency. COVID symptoms can range from subclinical, or asymptomatic to extremely severe with high mortality rate. The worsening of scenario arises when triad of underlying severity of immunodeficiency, along with complicated COVID and overlaid bacterial, or fungal infections arises. A Black fungus or Mucormycosis is one of the common and life threatening fungal infection. It is caused by eiher Rhizopus or Mucor species belonging to a group of Mucoromycotina. Many Indian studies are highlighting its association with COVID, in both acute phase and even recovered patients. A key factor for correlation amongst COVID-19 and mucormycosis is the decreased cluster differentiation 4 and 8 positive T-helper (CD4+ T and CD8+ T) cell counts. Though supplemented factors includes prolong hospital stays especially in ICUs, mechanical ventilation, use of steroids, anti-viral drug i.e remdesvir, and above all use of life saving immunomodulatory drug i.e tocilizumab. None of these can be avoided for COVID management. The risks and benefits used to be weighed for every choice of management. Though so far in Pakistan very few cases of black fungus are reported, but yet truly a threat for worsening situation can be there. Therefore, besides vigilant approach by health care workers, the community should be well aware from this coexisting condition [6, 7].
‘Black fungus’ is called as such because of specific pathogenesis events, which results in blackening of involved cells and tissues. This fungal infection can be acquired by inhalation of fungal spores from air or direct inoculation into ulcerated skin or inner layers of gastrointestinal. After entering into body the fungi destroys blood vessels, and penetrates into deeper layers of body, ultimately enters the bones. The infection usually spreads to the facial sinuses, eye orbits, layers of brain, and brain itself, within 03 days to 04 weeks’ time, the reported mortality rate ranges between 50% - 80% especially for the intraorbital or intracranial complications [8].
In view of seriousness of Black fungus infection, recognizing red flags for assessing the severity of illness harbors great significance. They can be in form of sinus pain, nasal stuffiness, black or bloody nasal discharge, persistent headache, fever, double vision, blurring of vision, abnormal bulging of eye balls, jaw or dental pain, non-healing ulcers of the palate, any neurological deficit, or infection of facial of skull bones. Presence of any of these symptoms must be taken care by consulting the physician. The diagnosis can easily be established by taking nasal swabs, samples from effected tissue, or tissue biopsy. The usually available tests includes staining of sample by potassium hydroxide or periodic acid Schiff, fungal cultures, ELISA and PCR studies. CT scan and MRI will be helpful to identify the extent of ‘black fungus’ infection. As soon the diagnosis confirms, aggressive management options with combination of injectable anti-fungal and surgical debridement should be used to stop the spread of infection [9-11].
Though for super added bacterial infections, antibiotics are usually given to COVID patients. But fungal infection in same manner necessitate attention. A vigilant approach for early assessing the symptoms, early case recognition by clinicians and timely management of ‘black fungus’ or mucormycosis is the only way out to combat this dangerous coinfection. The health care policy makers should provide updated protocols for this co existing infection. This will be helpful to reduce the miseries of COVID patients.
It is concluded that immunosuppression, anti virals, prolong hospital stay, use of tocilizumab and steroids as management of COVID predisposes to black fungus. Timely diagnosis and use of systematic anti fungals can reduce mortality rate form this co infection.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
